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Wound Healing Process in Post-bariatric Patients: an Experimental Evaluation

Obesity Surgery volume 20, pages 1552–1558 (2010)Cite this article

Abstract

Bariatric surgery is the most effective treatment for morbid obesity. Despite this, side effects are recorded. One of them is redundant skin hanging from the patients’ body causing both aesthetical and functional deformities. They can only be corrected with body contouring surgery, whose wound complication rate is very high in previously obese population. Despite several hypotheses, an adequate explanation is still awaited. The aim of our study was to evaluate the wound healing process in post-bariatric patients. Seven patients, six women and one man, were enrolled. They all were nonsmokers and nondiabetic. They all underwent biliopancreatic diversion (BPD). After 36 months, abdominoplasty was performed. Biochemical parameters before and after bariatric surgery were evaluated. The content of total protein and hydroxyproline was assessed in multiple scar biopsies before and after BPD. Abdominoplasty horizontal scar skin samples were subjected to histological evaluation with Weigert–Van Gieson stain for elastic fibers and connectivum. All biochemical parameters analyzed were reduced post-BPD compared to the preoperative period. Tissue proteins were significantly reduced after BPD both in their totality and as hydroxyproline and hydroxyproline/total tissue protein. Histological evaluation revealed abnormal dermal elastic and collagen fibers. The cause of aberrant healing in massive weight loss body contouring is likely multifactorial. A relationship between nutritional state, wound collagen accumulation, and elastic fiber content seems to be only partially involved. The high mechanical stress of tissues before BPD probably influences the wound healing process after BPD.

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The authors declare that they have no conflict of interest.

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Author notes

  1. Donatella Gniuli, Amerigo Iaconelli & Geltrude Mingrone

    Present address: Department of Metabolic Diseases, Institute of Internal Medicine, Catholic University, Rome, Italy

Affiliations

  1. Department of Plastic and Reconstructive Surgery, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy

    Marco D’Ettorre

  2. Institute of Anatomopathology, Catholic University, Rome, Italy

    Guido Massi

  3. Department of Plastic and Reconstructive Surgery, Catholic University, Rome, Italy

    Roberto Bracaglia

Authors
  1. Marco D’Ettorre
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  2. Donatella Gniuli
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  3. Amerigo Iaconelli
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  5. Geltrude Mingrone
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Correspondence to Marco D’Ettorre.

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D’Ettorre, M., Gniuli, D., Iaconelli, A. et al. Wound Healing Process in Post-bariatric Patients: an Experimental Evaluation. OBES SURG 20, 1552–1558 (2010). https://doi.org/10.1007/s11695-010-0224-x

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Keywords

  • Obesity
  • Biliopancreatic diversion
  • Massive weight loss
  • Vest over pants abdominoplasty
  • Wound healing
  • Hydroxyproline
  • Multiple scar biopsies
  • Elastic fibers
  • Mechanical stress